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Home My WebLink About2742-zFO~M NO. 4 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. CERTIFICATe OF OCCUPANCY THIS CERTIFIES that the building located at .......... ~/~...-.Dee~ho~.e..D~. .................. 'i.. Street Mop No ......~ .......... Block No ....... ~ ........... Lot No..-X~I; .......~..~;~:~,~;~,*.....N,.~'e ............. conforms substantially to the Application for Building Permit heretofore filed in '~this office dated ................................... Ma:/. ....... 10. ........... , 19.6~... pursuant to which Building Pe,~rnit No.....~..~..~.....~ dated ........................... ~......~1 ........... , 19..~.~., was issued, and conforms to all of I~the requirements of the applicable provisions of the Iow. The occupancy for which this cert~ficatels issued is ........ ...... P~.i.v.a.te .. ~ne ..~.amil.y... d.wel ling .............................................................. ,'r .............. The certificate is issued to ....~eA,~...l~...~..~,eM~.~..~..Hl,l~f3~eX~. .............~...~. ~ex'.~ .................... (owner lessee or tenant)/. of the aforesaid building. Il' H.D.Approval Nov. 1~, 196% by R, Villa i/~ I~ 'or Building Insp, [' ..................... FOKM NO, 2 TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD, N. Y. BUILDING PERMIT (THIS PERMIT MUST BE KEPT ON THE PREMISES UNTIL FULL COMPLETION OF THE WORK AUTHORIZED) Ne 2742 z Date ................................. Permission is hereby granted to: to · Bui.ltl...new-one..family..dve-t ttrg ..................................................................................... ct premises located at ...~/~....Dee'~...H~]:.e...~2.i. ve .......................................................................... ............................................... Ma~ti.t~k ............................................................................................. pursuant to application dated ................................ N~F......*iO ............ 19.../~ and approved by the Building Inspector Fee $ ...... '~'0~ '0~ ..... Building Inspecto/ SUFFOLK COUNTY DEPAEI~ME~T OF HEALTH Date Bg.dg, Permit TO WHOM IT MAY CONCERN: have been inspected by this Department and found to be satisfactory. The sewage disposal facilities for a structure located at D s r ct Engineer' ...... FORM NO. ! TOWN OF SOUTHOLD BUILDING DEPARTMENT TOWN CLERK'S OFFICE SOUTHOLD~ N. Y. Examined ....................................... , 19. Approved ........................................ , 19 ........ Permit No ............................. Disapproved a/c .......... ~. ;;.~,~z.: .............................. ................................ '~'i;;(~'i~,B"iT:/~'g~¥'o';i: ........................... Application No...~.~. ...................... APPLICATION FOR BUILDING PERMIT INSTRUCTIONS a. This application must be completely filled in by typewriter or in ink and submitted in duplicate to the Building Inspector. b. Plot plan showing location of lot and of buildings on premises, relationship to adjoining premiees or public streets or areas, and giving a detailed description of layout of property must be drown on the diagram which is part of this application. c. The work covered by this application may not'be commenced before issuo.nce of Building Permit. d. Upon approval of this application, the Building Inspector will issue a Building Permit to the applicant. Such permit shall be kept on the premises available for inspection throughout the progress of the work. e. No building shall be occupied or used in whole or in part for any purpose whatever until a Certificate of Occupancy shall have been granted by the Building Inspector. APPLICATION IS HEREBY MADE to the Building Department for the issuance of a Building Permit pursuant to the Building Zone Ordinance of the Town of Southold, Suffolk County, New York and other applicable Laws, Ordinances or Regulations, for the construction of bui dings, additions or a terations, or for removal or demolition, os herein described. The applicant agrees to comply with oil applicable lows, ordinances, building code and regulations. , ........................ i~i~"~¥'~'~ ................. ~ ~/ ...... State whether applicant is owner, lessee, agent, architect, engi.neer, general contractor, electrician, plumber or builder. ...... . .~..?.:.xc..,~//~...z.. ........ ...~....~ ~.~..¢..~..~. ................................................................................................................ Name of of premises .::~ ............ If applicant is a corporate, s~oture of duly authorized officer. ...... ........ ............... (~me and title of corporate officer) I. Location of land on which proposed work will be done. ,Mop No.: ........................................ Lot No.: ........................ Str,et ,~d ,umber .... ~.~...~ ...... JL~.~.~ ........ D~..~ ................... ~..~.~..~. ....... .&, .... Municipality 2, State existing use and occupancy of premises and intended use and occupancy of proposed construction: o. Existing use and occupancy b. ~,tend~d ,~ ~,d occap~,~ ............ ~.~N~.~.:.~ .................................................................................... 3. Natur~ of work (check which applicable): New Baildin~ Addition Alteration Repai~ .................. Removal .................. Demolition .................. Other Work (Describe) ...................................... ~'"~/ ......................................................................................... (to be paid on filing this application) 5. If dwelling, number of dwelling units ....... .~ ....... Number of dwelling units on each floor .......................... If garage, number of cars ........................................................................................................................................... 6. If bus,ness, commercial or mixed occupancy, specify nature and extent of each type of use .......................... 7. D~me0s~ons of existing structures, if any: Front ............................ Rear ................................ Depth .................... Hmg~t ........................ Number o Stones ................................................................................................................ Dimensions of same structure with alterations or additions: Front ....................................Rear DeptH'" ................................ Height ............................ Number of Stories ................................. il,, 8. Dimensions of entire new construction: Front ........ .................... Rear ........... ~..~. ........ Depth Height ....... ~..~.. Number of Stories .................... 10. Date~o~ Purchase ........................................................ Name of Former Owner 1 1. Zone or use district in which premises are situated ....................... 12. Does]proposed construction violate any zoning law, ordinance or regulation? ................... ~ ......... Name of Contractor .................................................... Address ............................................ Phone No. PLOT DIAGRAM Lac~te clearly and distinctly all buildings, whether existing or proposed, and indicate all set-back dimensions property lirgs. Give street and block number or description according to deed, and show street names and whether int~ nor or corner lot. STATE OF NE~ ~R~, ~/ ~ c ~ COUNTY )F ~ .......... ~ ...... z..~.~~' ............ ~ ~ ..................................... being' duly sworn, deposes and says th.at he is the ~N~ of individual s,gning application) above na~ed. He is the .............................................. ~.~%~. ~ (Contractor, agent, corporate officer, etc.) o~ner or owners, and is duly authorized to perform or have performed the said work and to make and said this oppliqation; that all statements contained in this application are true to the best of his knowledge and belief; that the wCrk will be performed in the manner set forth in the application filed therewith. Sworn to bkfore me this ] ~ ~o. 52-3233120 Suffolk i ~rm [xpires ~arch 30, 19~